The field of healthcare simulation continues to make tremendous strides to revolutionize healthcare education through clinical simulation research being conducted across the globe. Multiple peer-reviewed journals now focus on clinical simulation research. This HealthySimulation.com article by Content Manager Teresa Gore, PhD, DNP, APRN, FNP-BC, CHSE-A, FSSH, FAAN, provides an overview of some of the latest clinical simulation highlights as of November 2024.
The impact of simulation with debriefing on developing clinical competence and performance in paramedicine students: Paramedics handle diverse medical and trauma cases, where any lapse in competency can compromise patient safety. Student paramedics must meet high standards set by oversight bodies to protect both the profession and the public. Growing evidence indicates that simulation facilitates attainment and reinforcement of clinical competencies. However, limited evidence explores the impact of simulation and debriefing on developing clinical competence in undergraduate paramedicine students.
A retrospective analysis of performance-based assessment data (2019–2024) in a university paramedicine program evaluated the role of high-frequency simulation. Second-year students participated in weekly three-hour simulated practice sessions and a summative practical exam, with performance assessed using the Clinical Competence Assessment Tool (CCAT).
Data from 305 students and 1,251 practice scenarios revealed a significant positive correlation between practice frequency and exam performance (rs = 0.257, p < 0.001). Clinical competence scores improved progressively across the trimester, with the strongest correlation observed in the final tertile (rs = 0.229, p < 0.001).
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Nursing programs provide holistic education in caring for people with various health conditions, including mental health conditions. This study aimed to explore the experience of faculty regarding planning and implementing mental health simulation as a method for enhancing the mental health nursing competency training of undergraduate students. The researchers have adopted an action research design under the qualitative paradigm to find answers to the research questions. A purposive sample of nine participants, including mental health nursing faculty and simulation unit staff working in a public university in Oman were included in the study. Ethical clearance was obtained from the institutional ethics committee.
Data were collected through in-depth individual interviews with the faculty. Thematic analysis was done synchronously with the steps of action research through the process of coding, categorising and organising the data into meaningful themes. Member checking was done to ensure the transparency and correctness of the themes and subthemes. Seven themes were derived from thematic analysis of the transcripts, such as ‘Need for creating innovative mental health nursing learning experiences for students’, ‘Perceived readiness for simulation’, ‘Experience in developing mental health simulation’, ‘Arrangement of resources’, ‘The zeal for implementing simulation’, ‘Challenges in the simulation experience’, and ‘Gaining momentum and confidence’. A conceptual framework for simulation in mental health nursing was developed by the authors based on the findings and by referring to existing models. Faculty can effectively plan and implement simulation experiences for their students. Simulation-based training can become an effective means to make the students more confident and competent in mental health nursing. Implementation of simulation-based teaching will enhance the quality of nursing education and, thereby, the standard of mental health care in clinical settings.
Student survey of simulation standards for continuous improvement (S4CI): Establishing reliability and validity: This paper aims to describe the development of a tool, the Student Survey of Simulation Standards for Continuous Improvement (S4CI), to accurately measure student simulation experiences related to the 2021 International Nursing Association for Clinical and Simulation Learning (INACSL) Standards and the unique needs of University of Hawaiʻi (UH) Translational Health Science Simulation Center.
This study is designed as a cross-sectional survey study collecting data from nursing and Interprofessional Education students at the UH Mānoa. The authors reviewed existing tools and adapted items as needed with the consultation of subject matter experts. They validated the tool by administering surveys to nursing and interprofessional students following simulation exercises. Confirmatory factor analysis to verify the factor structure and reliability tests were performed to assess the internal consistency of each item within a measure, respectively.
Survey data from 1182 respondents showed reproducible factor results with strong correlation and reliability results showed high coefficient alpha values for all measures. The S4CI is a valid and standardized tool to provide faculty with valuable feedback to evaluate learning, optimize achievement and improve aspects of activities in nursing and interprofessional educational simulations. The study is, however, limited by sample size and generalizability, as it was conducted in a single center.
Improved Casualty Depiction System for Simulated Mass Casualty Exercises: Assessing military medical teams’ ability to respond to large-scale mass casualty (MASCAL) events has become a priority in preparing for future conflicts. MASCAL exercises rely on large numbers of simulated patients with limited medical training. Role-players must be appropriately prepared to ensure that medical exercises adequately assess the expected capabilities of military medical units. The Uniformed Services University of the Health Sciences (USUHS) has evaluated future military providers for decades using a large-scale, multiday, immersive simulation called Bushmaster. Despite a robust casualty training system, the fidelity of the portrayals remained limited.
Through collaboration with national military medical experts, a comprehensive casualty depiction system was developed. This system relied on structured casualty cards linked to time-based illness scripts. Structured casualty cards included an appropriate balance of disease non-battle injuries and trauma, included multipatient presentations based on shared events (i.e., multiple injured personnel due to an aircraft crash), normal and pathologic combat stress, population/unit considerations, requirements for different roles within the medical unit, and expected clinical outcomes. Illness scripts, supplemented by video guides, included time-based courses of illness/injury and prescribed responses to different typical treatments. This system was piloted during an annual MASCAL exercise (Operation Bushmaster) at USUHS. Clinical faculty were queried on the fidelity of this new system while role-players were evaluated on feasibility.
Three hundred casualty cards linked to 49 illness scripts were created, peer-reviewed, and piloted at Bushmaster. A total of 170 military members with limited medical training portrayed simulated patients utilizing the new casualty depiction system. Clinical faculty members strongly agreed that the improved casualty depiction system improved the realism of individual patient presentations (96%). Eighty-three percent of role-players strongly agreed that the casualty depiction system was easy to understand. This improved casualty depiction system was a feasible approach to enhance the fidelity of a MASCAL exercise. It has since been shared with military medical units around the globe to assist with their MASCAL exercises, making future multisite evaluations of this casualty depiction system possible.
Development of a virtual poverty simulation experience for healthcare learners:
Poverty is a pervasive challenge impacting social determinants of health. Healthcare educators must prepare students for social justice advocacy, but limited tools exist to accomplish this goal. An international interprofessional group developed an open-access poverty virtual simulation experience for healthcare students during a workshop. This simulation places students in the role of an individual living in poverty to promote empathy and reduce stigma. This virtual simulation is an innovative approach to teaching poverty concepts, has been used during interprofessional education, and has potential for international implementation. Further research is needed to test the impact of this simulation on educational outcomes.
Immersive and non-immersive virtual reality: A quasi-experimental study in undergraduate nursing education: Immersive virtual reality (VR) is considered more engaging and realistic than non-immersive VR, but direct comparisons in nursing education are limited. This non-randomized quasi-experimental study explored undergraduate nursing students’ experiences in a home care simulation experience using immersive VR at the university (via VR headsets) or non-immersive VR at home (desktop simulation). A post-test survey incorporating qualitative feedback assessed engagement, satisfaction, confidence in learning, cognitive load, mental effort, and clinical reasoning.
Engagement levels were similar across VR modalities. Immersive VR participants reported higher confidence and enthusiasm, while non-immersive VR participants reported greater mental effort and intrinsic cognitive load. Satisfaction, extraneous cognitive load, essential cognitive load, and clinical reasoning showed no significant differences between groups. Both immersive and non-immersive VR supported student engagement and learning. Remote, non-immersive VR emerged as a cost-effective alternative that offers similar educational benefits while requiring fewer resources.
Impact of virtual, augmented or mixed reality in basic life support training: A scoping review: New teaching tools using immersive and realistic environments have been introduced in basic life support (BLS) training. The aim of this scoping review was to assess the performance of virtual, augmented, or mixed reality in BLS training. A literature search was conducted to identify all published studies reporting on the assessment of virtual, augmented, or mixed reality in adult BLS training. Eligible articles were full-text, controlled trials. Studies on advanced life support or neonatal resuscitation were excluded.
The literature review identified 972 records. Out of 702 non-duplicate records, 662 were excluded based on title and/or abstract. After assessing the full texts of the remaining 40 articles, 25 studies were included. The wide heterogeneity of the included studies made comparisons and interpretations challenging. Overall, the available studies suggested that training using virtual, augmented, or mixed reality is no different from traditional courses. This scoping review shows that the use of virtual, augmented, or mixed reality in BLS training is a rapidly expanding area of research. However, current evidence does not establish their superiority over traditional courses.
The use of simulation to improve non-technical skills in undergraduate nurse education: A scoping review: This scoping review aim was to identify evidence about the use of simulation to improve nursing students’ non-technical skills in undergraduate curricula. Simulation in nurse education is rapidly advancing in non-technical skills. Evidence for the use of simulation in improving non-technical skills remains unclear. The scoping review used procedures guided by the Joanna Briggs Institute. Searching was undertaken through six databases. After title, abstract and full text review, 47 papers meeting the inclusion criteria were identified for analysis and synthesis.
The most frequently researched non-technical skills taught using simulation were communication and teamwork, with the most modalities being simulated patients or manikins. Few studies reported the use of evidence-based frameworks for simulation design. Forty-five studies evaluated student learning outcomes. Communication and teamwork were highly reported aspects of non-technical skills development using simulation. Studies evaluated students’ improvement in performance and understanding regarding the non-technical skills as well as their experiences of the simulation however, the effect of the simulation intervention was not always clear.
Simulation training in airway fire safety for certified registered nurse anesthetists:
Airway fire (AF) is a rare, sentinel event that certified registered nurse anesthetists (CRNA) may not be fully prepared to manage due to lack of mandatory intermittent training and clinical experience. This quality improvement (QI) project used a pretest, post-test, repeated measures design to assess whether CRNAs’ knowledge and technical skills in AF management improved three months after simulation-based education and training.
Compared to pre-implementation baseline scores, mean knowledge score and task completion competency increased by 20% (p < .001) and 12% (p = .002), respectively, and mean time-to-scenario completion decreased by 13.3 seconds (p < .001) 3 months postimplementation. AF training increased CRNA knowledge and technical skills necessary for managing an AF.
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